Leon Epstein

An outbreak of measles among young adults: Clinical and laboratory features in 461 patients

We report the clinical and laboratory characteristics of measles infection in an unselected group of 461 young adults. Otitis media was diagnosed in 9.8%, sinusitis in 4.1%, pneumonia in 3.7%, and keratitis in 3.3% of the patients. Minor T-wave changes on electrocardiogram were observed in only 0.7% and jaundice in 0.4%. Elevated liver enzymes were found in 51% of the patients. Creatine kinase (CK) MM fraction was high in 44%. Traces of myoglobin were found in the urine of 14% of those with a high CK, and of the 13 patients with the higher CKs, 12 had an abnormal serum aldolase. We emphasize several points of interest in this large and unselected group of young adults. There was 1) possible evidence of rhabdomyolisis in some of our patients; 2) a lower rate of electrocardiogram abnormalities than previously reported; 3) no evident correlation between initial laboratory values and subsequent complications; and 4) lack of a clinical or laboratory difference between patients who had been vaccinated with an attenuated virus during childhood and those who had not.

Health-related behavior of adolescents: change over time.

A longitudinal study of the changes in health-related behavior in Israeli adolescents was undertaken in a large, comprehensive secondary school. The incidence of starting to smoke and its relationship to the development of sexual behavior was assessed. Smoking, use of drugs, sexual behavior, and drinking of alcoholic beverages at the age of 16 years was related to dropout from secondary school during the 2-year study period. The possibility of developing a model of adolescent risk behavior and its relevance to planning of health and educational services is discussed.

Bowel habits in Israel : a cohort study

We interviewed 1,900 healthy subjects who belonged to one of the three following ethnic groups: (a) Ashkenazi Jews, (b) Sephardi and Oriental Jews, and (c) Arabs (including Druses)-about their bowel habits, laxative use, and beliefs about bowel action. Using stepwise logistic regression, we found that the following variables were significantly and independently related to bowel frequency: (a) sex-male > female (p = 0.0001); (b) age-young > old (p = 0.0001); (c) physical activity-high > little (p = 0.001); (d) body habitus-lean > obese (p = 0.02); (e) marital status-married > single (0 = 0.009); and (f) ethnic group-Arab > Jewish (p = 0.004). Regular use of laxatives was found in 18.4% of women and 10.8% of men (p < 0.0001). This habit was more common among Ashkenazi Jews (17%) than among Sephardi and Oriental Jews (10.7%) and Arabs (4.8%). Laxative intake was higher among the elderly (p = 0.0001) and the obese (p = 0.0004). Concerning the “ideal” bowel frequency, 12.4% of the Ashkenazis, 22.7% of the Sephardis and Oriental Jews, and 26.1% of the Arabs preferred to have at least 9 movements per week. Strikingly, 51.8% of all interviewed believed that constipation was “harmful to health;” women were more concerned than men (56.3% versus 47.5%). Subjects with a high level of education were significantly more concerned about constipation.

Observer variation in the interpretation of bone scintigraphy

To assess the reliability of bone scintigraphy, a random sample of 100 bone scans was reviewed twice by each of two physicians. Observer variation in the description and interpretation of bone scintigrams varied by diagnosis. Good to excellent k values were obtained for inter- and intraobserver variation in relation to metastasis or normal scans. For degenerative bone disease, as well as the specific agreement on major pathologies other than metastases, k values were found to be moderate. The agreement on the need for further radiographic studies was poor to moderate. The interpretation of bone metastases or normal scintigrams was found to be more reliable in a research setting than in the usual clinical framework, and the latter requires improvement. The interpretation of bone scintigraphy as consistent with degenerative changes is not reliable. The diagnosis should be evaluated by radiography.

Lung cancer in Israel, 1962-1982. I. Jews and Arabs.

The magnitude and dynamics of lung cancer incidence in Jews and Arabs in Israel between the years 1962 and 1982 were studied. In general, age-standardized incidence rates increased consistently between the years 1962 and 1976 among Jewish (24% increase) and Arab (39%) males, and to a lesser degree among Jewish females (15%). Arab females had the highest (77%) increase. From 1977 to 1982 a general decrease in incidence rates, which was largest among Arab males (19%) and females (15%), was noted. Rates among Jewish males are currently 26% higher than among Arab males, and are 162% higher among Jewish females than in Arab females. Lung cancer rates in both males and females in Istrael (Jews and Arabs) are lower than in most developed countries in the world. Among the possible reasons are differences in the population risk factors profile, availability of health care and the level of diagnosis and ascertainment of cases.

Lung cancer histology in major ethnic groups among the Jews. Israel, 1962-1982.

Lung cancer rates in Israel are lower than in other Western countries, not explainable by smoking habits. Due to the different relation of Squamous cell carcinoma (SgCC) and Adenocarcinoma (AC) with smoking it was of interest to study the histologic distribution in Israel. A total of 7508 histologically confirmed lung cancer cases among Jews were studied in the period 1962–82. SgCC was the leading tumor-type in Jewish men and AC in Jewish women. European-American born males in the last study period showed a decrease in SgCC rate while Asian-African born males showed a steep increase in SgCC rate, most prominent among the younger age-groups. Rates of AC increased in both, European-American and Asian-African males, but more steeply in the latter in most age-groups. Only for Large cell carcinoma were the overall rates higher in Asian-African than in European-American born males. SgCC increased in European-American born females and also steeply increased in the over 55 years old Asian-African born females. AC increased in European-American born females (both young and old), but only in the young Asian-African born females (decreasing in the older). European-American born Jews still have higher rates of both, more and less smoking related lung cancer histological types, than Asian-African born Jews. The steep increase in rates of some of the histological types m the latter with the pronounced increase in the younger age-groups is expected to cause a change in the ethnic rate-ratio which has already been demonstrated for the overall lung cancer rates. This probably reflects the acquisition of Western habits (mainly smoking) by the Jews from less developed countries.

Lung cancer in Israel, 1962–1982 II. Ethnic differences among Jews

Lung cancer incidence rates among Jews in Israel are significantly lower than in most developed countries in the world. A more detailed analysis of the rates among different Jewish ethnic groups also showed low rates. While Jewish males born in Europe-America (EA) had an 11% increase in rates between 1962–66 and 1977–82, Jewish males from Asian-African (AA) origin had a 45% increase resulting in current higher rates among North African than among East European Jews (the two dominant ethnic groups in Israel). In Jewish females, rates have been relatively stable from 1972 to 1982 and were almost twice as high for females born in EA than females born in AA with less prominent differences between countries. While smoking patterns probably explain the increase in rates among Asian-African Jewish males, other possible risk factors as well as the overall smoking prevalence cannot explain the low incidence in the major ethnic Jewish groups. The possibility of differed susceptibility is raised.

Health-related behavior in Israel adolescents

Eight hundred and four high school students were interviewed about selected health-related behaviors in an effort to determine the interrelationships of these characteristics. We found the age of onset and present use of cigarettes by the adolescents to be positively correlated to their use of hashish and having sexual intercourse. The use of hashish and having sexual intercourse were also positively related with each other and the use of hashish to drinking alcohol.

Blood pressure and hypertension in Israeli high school students

Abstract The results of the examination of blood pressure measurements in a population of Israel high school students are presented. There is a clear rise of both systolic and diastolic pressure with age (from 16–18 yr) in the males that is absent in the females. The differences are smallest in those pupils of Western origin. Blood pressure levels were related to an index of weight and height (Quetelet Index) and to the smoking habits of the thinnest group of pupils. The proportion of the students with raised levels of blood pressure were similar to those found in North American studies. The findings in this ethnically heterogeneous adolescent population are of relevance to the planning of health services (expecially preventive) for this age group.

Emotional health state of adolescents.

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